Toenails often serve as barometers of our health; they are diagnostic
tools providing the initial signal of the presence or onset of systemic
diseases. For example, the pitting of nails and increased nail thickness
can be manifestations of psoriasis. Concavity—nails that are rounded
inward instead of outward—can foretell iron deficiency anemia. Some
nail problems can be conservatively treated with topical or oral
medications while others require partial or total removal of the nail.
Any discoloration or infection on or about the nail should be evaluated
by a podiatric physician.
Ingrown nails, the most common nail impairment, are nails whose
corners or sides dig painfully into the soft tissue of nail grooves,
often leading to irritation, redness, and swelling. Usually, toenails
grow straight out. Sometimes, however, one or both corners or sides
curve and grow into the flesh. The big toe is usually the victim of this
condition, but other toes can also become affected.
Ingrown toenail may be caused by:
If you suspect an infection due to an ingrown toenail, immerse the
foot in a warm salt water soak, or a basin of soapy water, then apply an
antiseptic and bandage the area. People with diabetes, peripheral
vascular disease, or other circulatory disorders must avoid any form of
self treatment and seek podiatric medical care as soon as possible.
Other "do-it-yourself" treatments, including any attempt to
remove any part of an infected nail or the use of over-the-counter
medications, should be avoided. Nail problems should be evaluated and
treated by your podiatrist, who can diagnose the ailment, and then
prescribe medication or another appropriate treatment.
A podiatrist will resect the ingrown portion of the nail and may
prescribe a topical or oral medication to treat the infection. If
ingrown nails are a chronic problem, your podiatrist can perform a
procedure to permanently prevent ingrown nails. The corner of the nail
that ingrows, along with the matrix or root of that piece of nail, are
removed by use of a chemical, a laser, or by other methods.
Fungal infection of the nail, or onychomycosis, is often ignored
because the infection can be present for years without causing any pain.
The disease is characterized by a progressive change in a toenail's
quality and color, which is often ugly and embarrassing.
In reality, the condition is an infection underneath the surface of
the nail caused by fungi. When the tiny organisms take hold, the nail
often becomes darker in color and foul smelling. Debris may collect
beneath the nail plate, white marks frequently appear on the nail plate,
and the infection is capable of spreading to other toenails, the skin,
or even the fingernails. If ignored, the infection can spread and
possibly impair one's ability to work or even walk. This happens because
the resulting thicker nails are difficult to trim and make walking
painful when wearing shoes. Onychomycosis can also be accompanied by a
secondary bacterial or yeast infection in or about the nail plate.
Because it is difficult to avoid contact with microscopic organisms
like fungi, the toenails are especially vulnerable around damp areas
where people are likely to be walking barefoot, such as swimming pools,
locker rooms, and showers, for example. Injury to the nail bed may make
it more susceptible to all types of infection, including fungal
infection. Those who suffer from chronic diseases, such as diabetes,
circulatory problems, or immune-deficiency conditions, are especially
prone to fungal nails. Other contributing factors may be a history of
athlete's foot and excessive perspiration.
Treatment of Fungal Nails
Treatments may vary, depending on the nature and severity of the
infection. A daily routine of cleansing over a period of many months may
temporarily suppress mild infections. White markings that appear on the
surface of the nail can be filed off, followed by the application of an
over-the-counter liquid antifungal agent. However, even the best
over-the-counter treatments may not prevent a fungal infection from
A podiatric physician can detect a fungal infection early, culture
the nail, determine the cause, and form a suitable treatment plan, which
may include prescribing topical or oral medication, and debridement
(removal of diseased nail matter and debris) of an infected nail.
Newer oral antifungals, approved by the Food and Drug Administration,
may be the most effective treatment. They offer a shorter treatment
regimen of approximately three months and improved effectiveness.
Podiatrists may also prescribe a topical treatment for onychomycosis,
which can be an effective treatment modality for fungal nails.
In some cases, surgical treatment may be required. Temporary removal
of the infected nail can be performed to permit direct application of a
topical antifungal. Permanent removal of a chronically painful nail,
which has not responded to any other treatment, permits the fungal
infection to be cured, and prevents the return of a deformed nail.
Trying to solve the infection without the qualified help of a
podiatric physician can lead to more problems. With new technical
advances in combination with simple preventive measures, the treatment
of this lightly regarded health problems can often be successful.
This pamphlet is one of a series produced by APMA that discusses several foot health conditions and concerns, including diabetes, arthritis, high blood pressure, athleteís foot, occupational foot health, warts, foot health, aging, childrenís feet, surgery, Medicare coverage, injuries, heel pain, orthoses, walking, womenís feet, footwear, and others. The pamphlets are available from many podiatrist members of APMA.